programme budget 2014 2015 performance assessment...

PBPA2014-2015 (April 2016) 1 PA: 5.1 Alert and Response Capacities

Programme budget 2014–2015 performance assessment Programme area: 5.1 Alert and response capacities

Outcome 5.1 All countries have the minimum core capacities required by the International Health Regulations (2005) for all-hazard alert and response

I. OVERVIEW OF MAJOR ACHIEVEMENTS AND CHALLENGES In 2014 the work under this programme area was dominated by the response to the unprecedented Ebola virus disease outbreak in West Africa. The department of Global Capacities Alert and Response Department (GCR) –in close collaboration with the Department of Pandemic and Epidemic Diseases and with the Emergency Risk and Crisis Management, provided overall operations for crisis management. WHO supported response operations in collaboration with the United Nations Mission for Ebola Emergency Response; assisted development and implementation of guidance on Ebola case management at ports, airports and ground crossings and recommendations on international travel and transport; provided support to laboratory diagnostics; and developed a comprehensive package of pre-deployment trainings. In the last quarter of 2014, in addition to Ebola virus disease operational support and guidance, a special group was set up to scale up preparedness in countries at risk of Ebola in West Africa. Between September and December, WHO deployed international preparedness strengthening teams to 14 countries to help them plan preparedness activities. The scaled-up capacities will be maintained to address all potential health risks following the International Health Regulations (IHR) (2005) all-hazards approach. Throughout 2015, support to countries in attaining the core capacities required under the IHR remained a top priority. Recognizing that many countries are still struggling towards attaining the minimum capacities, significant efforts have been made to bridge the gaps through the development of educational materials, guidelines and tools to facilitate the implementation of the IHR across sectors, including online tutorials for national focal points; guidance documents on implementation of an early warning and response system with a focus on event-based surveillance; and application of the web-based Laboratory Quality Stepwise Implementation tool and operational frameworks to facilitate collaboration at the interface between the human and animal health sectors. In parallel and further to the recommendations of the IHR Review Committee in November 2014 calling for WHO to identify a new approach to monitoring and evaluation of the core public health capacities laid out in the IHR (2005), the Secretariat and the six WHO regional offices undertook extensive discussions to identify options for improving the monitoring and evaluation process. Based on these discussions, a new framework was developed, which included a self-administered reporting tool, after-action review, exercises and external evaluation. The framework was discussed at the regional committees in 2015 and then presented to the Executive Board in January 2016. In its role as IHR Secretariat, WHO convened nine IHR emergency committees for Middle East respiratory syndrome coronavirus (MERS-CoV), polio and Ebola virus disease in 2014, and 12 IHR emergency committees for the same diseases in 2015. In addition, four IHR review committees were convened at WHO HQ in Geneva in 2015 to review the functioning of the IHR in light of the unprecedented Ebola virus disease outbreak. To facilitate more accurate monitoring and evaluation of IHR core capacities, a new more flexible approach was called for, to allow a combination of qualitative and quantitative approaches with external evaluations, after-outbreak review and exercises. However, significant gaps remain in preparedness and readiness to respond to outbreaks, posing risks not only to the countries concerned but also to the entire global community. HQ and regional and country offices are currently understaffed, and this undermines rapid and efficient outbreak response when faced with public health events of the magnitude of the Ebola virus disease outbreak in West Africa.


II. OUTPUT MEASUREMENT

Output 5.1.1 Countries enabled to develop core capacities required under International Health Regulations (2005)

Output indicator

Baseline

Target

Achieved value

Proportion of countries supported that have met and sustained International Health Regulations (2005) core capacities within the biennium

50% 100% TBC

Overview of achievements and challenges

Working in close collaboration with the Secretariat, the regions and countries focused on building the core capacities to fulfil their responsibilities under the IHR (2005) and thereby contributing to strengthening global health security. Assessing current capacities and developing national plans based on priority areas also remained a focus. In 2015, the Secretariat and the six WHO regions worked together with technical partners to identify new approaches to monitoring the IHR core capacities, and a new framework was developed at the close of the biennium. Innovative approaches to building capacities were developed in the regions, such as the Better Labs for Better Health in the European Region, and joint initiatives between the Secretariat and the regions were developed, such as the rapid response training packages with the African and Eastern Mediterranean Regions.

Achievements and challenges in countries

Technical support was provided to six countries in the African Region to conduct IHR core capacity assessments and develop national plans. A total of 45 countries have now conducted IHR core capacity assessments and developed IHR national implementation plans. All Ebola-affected and high-priority countries received support to implement preparedness and response plans in the context of Integrated Disease Surveillance and Response (IDSR) and IHR through technical guidance, resource mobilization and onsite visits. The Congo received support for preparedness and response to public health events in relation to mass gatherings, as it related to the All-Africa Games that took place in Brazzaville in September 2015. Five countries received support for on-site country evaluations of their airports, including assessments of capacity for event management at points of entry, in close collaboration with the International Civil Aviation Organization. Algeria received training support for port health staff responsible for ship sanitation inspection and ship sanitation certificate issuance, and individual on-line trainings were organized for the same capacity via the WHO PAGnet (ports, airports and ground crossings network) website. Trainings on MERS-CoV and Ebola laboratory confirmation were carried out in eight and nine countries respectively. Four countries received support for adoption of IDSR technical guidelines and training materials. In the European Region, the Better Labs for Better Health initiative created a mentor pool comprising laboratory quality specialists capable of providing on-site and remote mentoring to laboratories moving towards ISO 15189:2012 accreditation, with the first mentoring visit taking place in the St Petersburg National Influenza Centre in November 2015. The Ministries of Health in Moldova and Tajikistan endorsed the laboratory policies developed through the Better Labs for Better Health initiative. A number of workshops were organized in the regions to facilitate national dialogue across different disciplines, in particular on biorisk management and infectious substances shipping (November 2015) as part of the Better Labs for Better Health initiative, health security at points of entry and border crossings capacity assessment (organized jointly with the European Commission) risk communications, IHR and coordination mechanisms. Table-top exercises to simulate multistakeholder coordination, cooperation and information exchange in the context of a public health emergency were also organized.


Overall, the majority of the States Parties in the European Region have met the required IHR capacities. The functionality of the IHR in the European Region is limited, however, not because of insufficient IHR capacities, but because of lack of awareness and ability to use the available capacities on a day-to-day operational basis and certain training gaps. Many countries in the Eastern Mediterranean Region are making progress towards implementation of the IHR capacities. Countries have partially achieved the required deliverables. The countries that reported having met the IHR obligations by 2014 have achieved the following: development and implementation of the national plan for the attainment of IHR capacities; enhanced multisectoral coordination and facilitated national dialogue across different disciplines; identification of the roles and responsibilities needed to meet the IHR requirements; and coordination with the IHR national focal point to review, analyse and use national information, and report on IHR implementation. Despite these achievements, further work is needed to enhance and sustain these achievements. Two Member States in the South-East Asia Region (Indonesia and Thailand) have achieved the IHR (2005) core capacities. Levels of IHR core capacity implementation vary significantly both between countries and across capacities. Major progress was observed in the 11 Member States in the area of legislation and the establishment of IHR national focal points; coordination and transparency in events reporting; early warning systems; communication and collaboration between the animal and human health sectors; establishment of emergency response and coordination structures; and international mechanisms to share information for rapid response. Seven out of 11 Member States have external quality assurance schemes for public health laboratories, and nine have at least one functional national influenza centre. Tripartite coordination between WHO, the World Organisation for Animal Health (OIE) and the Food and Agriculture Organization of the United Nations (FAO) has been established. Eight out of 11 Member States have standard operating procedures and guidelines for infection prevention and control. All Member States have risk communication plans and have identified partners, key stakeholders and spokespersons. All Member States have public health emergency response procedures in place, and most have conducted simulation exercises to test their response plans. In the Western Pacific Region, the Asia Pacific Strategy for Emerging Diseases (APSED) has proved to be an effective framework for promoting individual and collective action by Member States and partners, and for mobilizing resources. The APSED evaluation confirmed that the strategy remains relevant to developing capacities to deal with a variety of public health emergencies, using a generic and step-by-step approach. Together with other mechanisms, APSED has made significant contributions to collective health security. Challenges in countries include the fact that in many States Parties the IHR remains poorly understood, particularly outside the health sector (for example in the areas of emergency management, environment, border control, airport and port authorities, customs and trade, food safety, veterinary, agriculture, radio-nuclear and chemical safety). This has a negative impact on multisectoral coordination of the IHR. Risk communication and outreach to a wider public during an emergency remains a challenge, where risk communication plans and provisions are lacking and roles are poorly defined. The monitoring approach based on traditional assessment tools and checklists has been insufficient and needs to be complemented with other monitoring and evaluation approaches (simulation exercises, after-action reviews, peer assessments) in order to capture more complex capacities and functionality. Specific technical areas that require strengthening include chemical, radio-nuclear and food safety capacities, and points of entry also remain an important challenge.

Achievements and challenges at regional and global levels To support the Ebola response in the African Region, the Secretariat mobilized funds through Ebola virus disease preparedness channels to support 17 countries in the African Region at risk of Ebola virus disease to strengthen their capacities. Progress reports on the status of Ebola virus disease preparedness were developed and disseminated.


A total of 32 countries out of 47 responded to the IHR self-assessment monitoring questionnaire in 2014; and 32 countries and the Regional Office for Africa regional profiles were developed. So far, 21 countries have requested another two years’ extension up till 2016. Essential reagents and supplies were procured for confirmation of Ebola, influenza and other epidemic-prone diseases. Ebola virus disease rapid response team training modules were developed in line with IDSR/IHR and piloted in three countries. IDSR e-learning training modules were developed, and Ebola-specific training materials were developed in line with IDSR. Information products on IDSR and on IHR were regularly shared with stakeholders for decision-making. In the Eastern Mediterranean, the regional plan has been developed and implemented. The plan focuses on the regional deliverables of providing technical support to all countries in the Region towards IHR capacity strengthening. Many activities were tailored to enhance capacities at points of entry, where the majority of countries are facing many challenges. Assessment of IHR capacities in the context of Ebola were conducted in all countries in the Region and support was giving accordingly in coordination with the other concerned units in EMRO and in collaboration with partners. Country-specific tools, guidelines and training materials were developed. Some tools were adapted from global level to country-specific tools. Several advocacy activities were conducted to raise awareness of and increase political commitment to the core capacity requirements for the IHR. A regional report and a profile for each country were developed on the progress in IHR implementation. Overall, the global focus in the European Region has shifted from perceiving the IHR as a capacity development framework to a tool informing epidemic intelligence on a day-to-day basis in an operational way. This shift reveals a better understanding by Member States of the routine operational nature and added value of the IHR, rather than purely meeting the minimum core capacities requirement. But it is understood that the current modality of IHR monitoring and evaluation based largely on self-assessments performed by the Member States since 2010 is not reliable, as it does not provide adequate reflection of country capacities in place. This does represent a significant challenge, as the information and scoring received from the countries cannot be used for planning. At present, efforts are ongoing to revise the IHR Monitoring and Evaluation Framework in favour of a multifaceted approach oriented towards capturing the functionality of the IHR, which will include independent evaluations and real-time exercises, while moving away from self-assessments only. The six WHO regional offices were actively involved with the Secretariat in shaping this new approach. In the South-East Asia Region, progress has been made on the development of core capacities required for implementation of the IHR in Member States, although much needs to be done to strengthen and sustain it. All but two Member States (Indonesia and Thailand) requested an extension of the minimum core capacities deadline to June 2016. Accordingly, the Member States in the Region have provided their implementation plans along with the extension request. The Member States’ self-monitoring reports of IHR core capacities for 2014 are currently available from all Member States in the Region. To further strengthen Member States’ capacities, the Western Pacific Regional Office provided continuous technical advice in the areas of surveillance and risk assessment, laboratory strengthening, infection prevention and control, risk communications, and monitoring and evaluation, via a series of informal consultations, regional trainings, IHR exercises and external quality assessments. The annual regional Technical Advisory Group (TAG) meeting, outbreak reviews, and APSED evaluation served as key mechanisms for the Member States, TAG members and WHO to review progress and agree on priority activities for the work plan implementation. The IHR Pacific meeting served as a critical forum for Pacific Islands Countries. Due to their large differences in economic, political and population situations, the States Parties in the Western Pacific Region face a wide variety of challenges to implementing the IHR core capacities. These challenges include training sufficient staff to manage surveillance and response programmes, poor infrastructure in certain areas, and economic issues. Other challenges in the Region include insufficient funding and human resources at the regional level.


Risks and assumptions

A number of consultations conducted through the regional committees allowed development of the plan to address the provision of the new tools and indicators.

A number of short-term contracts were raised.

Advocacy was undertaken for more regular budget allocation for core activities.

Outsourcing, collaboration with Global Outbreak Alert and Response Network (GOARN) partners, use of rapid response teams from governmental institutions, foreign medical teams, and infection prevention and control networks have enabled the shortage of human resources to be overcome.

Flexible plans were developed to facilitate implementation in the needed and accessible countries.

Some activities were implemented by the country offices for specific countries.

Communication with national focal points was maintained to facilitate obtaining approval of countries and implementing planned activities.

A regional mechanism has been developed (the IHR Regional Assessment Commission) to help in identifying gaps in countries and priority actions to accelerate the implementation of the IHR.

Gender, equity and human rights, and social determinants of health

Programme activities in the area of IHR are guided by the legally binding international agreement, the IHR (2005), 2nd edition, signed by 196 countries across the globe, including all Member States of WHO. The IHR (2005) contains the general requirement that implementation of the IHR in countries must be carried out “with full respect for the dignity, human rights and fundamental freedoms of person” (Article 3, Principles). Similarly, Article 32 on Treatment of travellers requires that States Parties “treat travellers with respect for their dignity, human rights and fundamental freedoms and minimize discomfort or distress associated with such measures, including by: (a) treating all travellers with courtesy and respect; (b) taking into consideration the gender, sociocultural, ethnic or religious concerns of travellers; and (c) providing or arranging for adequate food and water, appropriate accommodation and clothing, protection for baggage and other possessions, appropriate medical treatment, means of necessary communication if possible in a language that they can understand and other appropriate assistance for travellers who are quarantined, isolated or subject to medical examinations or other procedures for public health purposes.” Under APSED in the Western Pacific Region, gender cuts across all eight focus areas, and when gender differences are observed in a particular disease epidemiology, it is necessary to consider whether this is due to biological factors or rather differential access to health services. The regional ESR team appointed a gender focal point to consider gender-based approaches when necessary. The focal point is part of a technical working group that includes cross-divisional colleagues. The group’s aim is to work together to find practical and strategic ways to manage these issues. O


2. Countries and partners enabled to develop and implement programmes and plans to prevent

Output 5.1.2 WHO has the capacity to provide evidence-based and timely policy guidance, risk assessment, information management and communications for all acute public health emergencies

Output indicator

Baseline

Target

Achieved value

Proportion of WHO offices fully meeting standards for event-based surveillance and risk assessment

60%

100%

TBC

Overview of achievements and challenges

The three main areas of work in the biennium were (a) building upon and strengthening a WHO event-based surveillance system with harmonized standard operating procedures to facilitate rapid identification and response to public health events of international concern; (b) risk communication capacity-building, including the development of national risk communication plans and mechanisms; and (c) building surge capacity.

Achievements and challenges in countries In the African Region, risk assessments were conducted for yellow fever (two countries), cholera (six countries), Marburg virus disease (one country), typhoid fever (two countries), chikungunya virus disease (one country) and Ebola virus disease (41 non-affected countries). Support to countries was strengthened through the reactivation of the AFRO Epidemic Emergency Committee (Ebola virus disease in West Africa, Ebola in the Democratic Republic of the Congo, Marburg disease in Uganda, flood and cholera in Malawi and Mozambique, cholera in the Democratic Republic of the Congo and the United Republic of Tanzania, and the humanitarian crisis in Ethiopia). The main challenges at country level are inadequate mechanisms for media monitoring and early warning, the limited number of trained and functional rapid response teams at all levels of the health system, lack of outbreak preparedness plans in some countries, and infrequent sharing of public health information by countries, resulting in delayed response. In the Eastern Mediterranean Region, there was a marked improvement among the majority of WHO offices that follow the WHO event-based surveillance and risk assessment system and procedures for identification of public health events of international concern. A number of country offices were involved in risk assessment and risk communication activities related to public health events, and played a crucial role in communications with national counterparts and other stakeholders. Nevertheless, in four country offices, event-based surveillance and risk assessments activities were not maintained due to instability in these countries. In the European Region, on-the-job training of IHR national focal points and WHO Alert and Response Operations staff actually takes place during all events that trigger communications between IHR national focal points and WHO. During the 2014–2015 biennium, a total of 81 these events were recorded in the WHO Event Management System for the Region. In cases in which the IHR national focal point response to the request for verification was slow, the WHO country offices often played a crucial role in providing assistance to the IHR national focal point by facilitating communications with WHO and strengthening the IHR national focal point function. A total of 27 of 53 European Region Member States participated in direct capacity-building in various aspects of public health event management (especially risk assessment and risk communication), jointly offered by the outbreak, IHR coordination and communications teams during the biennium. Many of these countries also participated in table-top exercises.


Language barriers remain a challenge in the European Region, as many members of the IHR national focal point institutions are not English speakers in the eastern parts of the Region. Relatively frequent changes of IHR national focal point staff is another challenge, calling for continuous training of new staff, which is currently not carried out in a systematic manner. Finally, the limited number of staff (two grade P staff and 0.5 grade G staff) during almost the whole biennium limited the ability to support more capacity-building in countries. All 11 Member States In the South-East Asia Region have a list of priority diseases, conditions and case definitions. Ten Member States analyse surveillance data on epidemic-prone and priority diseases at least weekly at national and subnational levels, though more work needs to be done to strengthen detailed analysis of data. Nine Member States have identified appropriate information sources for public health risks. In the area of risk communication, all Member States have identified partners, stakeholders and spokespersons to communicate on public health events. Nine Member States have risk communication plans in place. Nine Member States have standard operating procedures and guidelines for disseminating information during an emergency, and 10 have regularly updated information for the media and the general public. Ten Member States also have information, education and communication materials tailored to the needs of the population. The majority of Member States have informed populations and partners of a real or potential risk within 24 hours following confirmation of the event. Media training has also been conducted in most Member States, and various communication channels have been tailored to the needs of affected populations. In addition, a joint assessment between the WHO Regional Office, WHO country offices and national health authorities has been conducted in nine Member States of the Region. The objective was to ensure the Member States are operationally ready to effectively and safely detect, investigate and report potential outbreaks. The findings from this assessment have been communicated back to the respective Member States for their information and necessary actions. Sustaining communication on emerging infectious diseases and ensuring that populations are not only aware of but also adopt appropriate protective behaviours at the public and professional levels is an important challenge for risk communication in Member States in the South-East Asia Region. Although many Member States have specific risk communication plans, only a few of these have been regularly assessed. The majority of Member States have focused on health emergency communication and behaviour communication; however, the operational communications between the public health authorities, decision-makers and other stakeholders are still not clearly defined in many Member States. The Western Pacific Region provided technical support on risk assessment and response for acute public health events and emergencies, including for MERS in the Republic of Korea, avian influenza A (H7N9) in China, measles outbreaks in Asia and in Pacific island countries and areas, dengue and arbovirus outbreaks in the Pacific, Typhoons Haiyan and Lando in the Philippines, Cyclone Pam in Vanuatu and Tuvalu, and flash flooding in the Solomon Islands. Regional and country office staff members were deployed to West Africa to support the global response efforts. Following the WHO Global Policy Group discussions, the Western Pacific Ebola Support Team was established in December 2014 under the Regional Director. This team approach ensured effective work in the field, and continuity and sustainability in supporting response efforts. It also provided a platform for national experts to engage in international responses. The Ebola virus disease outbreak has also provided opportunities for the Region to test the capacity for response and preparedness under the Emergency Response Framework and APSED.

Achievements and challenges at regional and global levels

In the African Region, essential medicines and supplies were delivered to support response to major public health events in the affected countries; and over 500 multidisciplinary experts were deployed to support Ebola response operations in the Democratic Republic of the Congo, Guinea, Liberia, Mali, Nigeria, Senegal and Sierra Leone. Mapping and monitoring of major public health events was carried out on a regular basis and information on these events was shared via monthly outbreak bulletins (58 public health events were reported by 32 Member States during the biennium).


Rapid response team capacity was enhanced through deployments to the Democratic Republic of the Congo, Guinea, Liberia, Mali, Nigeria, Senegal, Sierra Leone and Uganda for response to viral haemorrhagic fevers; hands-on training workshops on PHEOC for six countries was conducted; and on-site and online training on the use of the VSHOC interactive mapping system was provided to concerned technical and administrative staff at AFRO intercountry support teams and WCO VSHOC focal points. In addition, the strategic health operations centre in the African Region developed and published standard operating procedures to strengthen surveillance and response. Absence of mapping information on epidemic-prone zones in the Region remained a challenge; the rapid response team at the regional level is frequently overwhelmed by the number of major public health events in the Region. Procedures are in place for the WHO event-based surveillance and risk assessment system in the Regional Office and country offices for all identified events in the Eastern Mediterranean Region. Public health events notified by national focal points are assessed jointly by the Secretariat and the Regional Office and information is made available on the event information site; however, the time frame specified under Article 6 of the IHR is not always met. Media rumours on public health events are verified in accordance with Annex 3 of the IHR, and risk assessments are carried out for all verified events. Coordinated response and surge capacity were provided to support countries in the MERS response and in relation to the importation of any Ebola cases. The Region also worked with the Secretariat on coordination of the H5N1 outbreak response in Egypt, the dengue outbreak in Sudan and the cholera outbreak in Iraq. Work is ongoing on the development of a regional alert and response network. The main achievement of the European Region Alert and Response Operations programme during 2014–2015 was the maintenance of the IHR contact point 24/7 function with only two grade P staff members. No important outbreaks or public health events caused by other hazards were missed during the biennium. In addition, Alert and Response Operations staff found time to contribute to many capacity-building workshops and some country assessments (even supporting other regions). Alert and Response Operations staff also attended meetings of networks, including GOARN, the Radiation Emergency Medical Preparedness and Assistance Network (REMPAN), and the European Centre for Disease Prevention and Control (ECDC), as well as global WHO meetings. Alert and Response Operations staff also contributed to the emergency training of national professional officers in late 2015. Since mid-2015, the team has been increasingly involved in the global reform of WHO’s work in outbreaks and emergencies. While this reform represents new opportunities for enhancing outbreak and emergency response, it caused a considerable amount of additional work during the last months of 2015, and the workload is likely to further increase during the first half of 2016. The South-East Asia Regional Office has been working closely with Member States to build capacity and preparedness and develop a framework for risk communications at the national level. The Regional Office coordinated the seventh and eighth bi-regional meetings of national influenza centres and influenza surveillance. The objective of this meeting was to provide a platform for sharing new information on emerging respiratory pathogens and their diagnosis, and to explore opportunities for networking with regional and reference laboratories to enhance capacity and preparedness for responding to these emerging respiratory infectious diseases. The Regional Office has also developed risk communication materials, such as frequently asked questions on communicable diseases (including dengue, chikungunya and Japanese encephalitis), and posters and leaflets on dengue, hepatitis and various zoonotic diseases. In addition, the Regional Office developed and distributed to all 11 Member States A brief guide to emerging infectious diseases and zoonoses, and this guide has also been translated into the local and national languages of the respective Member States. Furthermore, the Regional Office has provided support for national capacity development in the area of risk assessment, whereby 10 Member States have been trained on risk assessment in line with the IHR (2005), taking into account Ebola preparedness and response. Risk communication has been scaled up in the Region; 11 Member States and media experts have received risk communication training.


Increasing capacity in the Member States for event-based surveillance, risk assessment and communication in the Region remains a challenge. Adequate funding support for the Regional Office is pivotal. Without this, the Regional Office will not be able to sustain its human resources for provision of technical support to Member States. The Western Pacific Region continued to strengthen its regional system for early detection, verification, risk assessment and information sharing of disease outbreaks and public health emergencies, such as H7N9, MERS and Ebola virus disease, using an all-hazards approach. This approach includes recognition of gender in public health emergencies through disaggregation of surveillance data by sex and age, tailored infection prevention and control documents, and inclusion of gender aspects in risk communication strategies. The Field Epidemiology Training Programme fellowship initiative, an integral part of this surveillance system, contributed to human resource development through on-the-job training of fellows in Member States. Regional surveillance, risk assessment and response systems were further enhanced via the use of the state-of-the-art emergency operations centres, field epidemiology training fellowship programmes, and maintenance of regional stockpiles and logistics. The Western Pacific Surveillance and Response Journal, a regional information platform, contributed to timely information sharing for action. As part of regional preparedness, the regional stockpile of antivirals and personal protective equipment was maintained for deployment, and simulation exercises were carried out. To strengthen capacity, staff received training in WHO’s Emergency Response Framework.

Risks and assumptions

Extensive fundraising activity enabled additional funding to be attracted, for example from the Department for International Development (DFID) and the Centers for Disease Control and Prevention (CDC).

Training of WHO staff at country level was carried out to enhance their capacity to be part of the WHO event-based surveillance and risk assessment system.

The involvement of the country offices in the identification, risk assessment and notification of such events was crucial thorough face-to-face meetings with nationals and through field visits to the affected areas.

Regular teleconference and videoconference meetings with WHO country offices took place to follow up on potential events and coordinate the response to them.

Gender, equity and human rights, and social determinants of health Two examples from the European Region: Balkan floods and post-disaster needs assessment Following the Balkan floods in May 2014, affecting Bosnia and Herzegovina, Croatia and Serbia, the Regional Office for Europe and the Secretariat provided support to the Bosnia and Herzegovina country office on the ground. The direct damage to health facilities was relatively limited, but the indirect costs due to revenue losses were estimated to be very high. These indirect costs were first ignored by the World Bank and the European Union, but WHO succeeded in taking these costs into consideration in the post-disaster needs assessment in close cooperation with the ministries of health of the two entities of Bosnia and Herzegovina. This required mediation of complex negotiations between the two entities. Inclusion of the indirect costs caused by the flooding to the health sector helped in recovery of basic services to the flood-affected populations and therefore contributed to more universal access to health services. Ukraine early warning system for conflict-affected areas During the 2014–2015 biennium, the military conflict in eastern Ukraine caused large-scale population displacements, with consequences for the entire country. The Ukraine country office, together with the health cluster partners, established mobile emergency primary care units in the regions most affected by the conflict. EURO worked with GOARN to identify an epidemiologist to develop an early warning system for the use of mobile emergency primary care units in the last months of 2015.


This “Epiewarn” tool was further expanded to cover vulnerable Roma populations through so-called Roma health mediators. This system aims at detecting priority health issues among the vulnerable internally displaced and Roma populations and improving their access to health services. In the Western Pacific Region, WHO’s all-hazards approach includes recognition of gender in public health emergencies through disaggregation of surveillance data by sex and age, tailored infection, prevention and control documents, and inclusion of gender aspects in risk communication strategies.

III. SUMMARY OF FINANCIAL IMPLEMENTATION FOR THE PROGRAMME AREA

2014-2015 (US$ 000) AFRO AMRO SEARO EURO EMRO WPRO HQ Total

WHA approved budget 8,400 6,300 6,000 7,500 5,000 15,100 49,700 98,000

Funds Available (as at 31 Dec 2015)

Flexible Funds 5,248 2,051 3,371 1,575 2,800 2,828 18,716 36,589

Voluntary Contributions Specified 4,587 0 4,427 3,788 5,747 9,775 21,492 49,816

Total 9,835 2,051 7,798 5,363 8,547 12,603 40,208 86,405

Funds available as a % of budget 117% 33% 130% 72% 171% 83% 81% 88%

Staff costs 3,156 1,612 4,059 2,677 2,224 5,395 29,214 48,337

Activity costs 5,884 469 2,865 2,496 5,223 7,128 7,793 31,858

Total expenditure 9,040 2,081 6,924 5,173 7,447 12,523 37,007 80,195

Expenditure as a % of approved budget 108% 33% 115% 69% 149% 83% 74% 82%

Expenditure as a % of funds available 92% 101% 89% 96% 87% 99% 92% 93%

Staff expenditure by Major Office 7% 3% 8% 6% 5% 11% 60% 100%

Major financial implementation issues that affected programme delivery

Programme area 5.1 mobilized resources through grants obtained from, for example, the CDC, United

States Agency for International Development (USAID), DTRA, DFID and the European Union to

implement the key activities.

Implementation of some activities was not possible in some countries due to their instability, and

implementation of some regional activities was not possible as priority had to be given to enhancing

the capacities of countries to respond to the potential importation of Ebola cases.

In the Regional Office for Europe, with the exception of work on building laboratory capacity, there

was no sustainable funding and staffing available for either the Alert and Response Operations or the

IHR programme. However, the reform of WHO’s work in outbreaks and emergencies might provide

some additional funding in future.

In the Regional Office for Africa, additional resources are needed to scale up planned activities,

including IDSR and IHR implementation, and enhancement of alert and response capacities. There is

also an urgent need to recruit a laboratory and containment focal person and an IHR focal person for

the next biennium.

In the Regional Office for South-East Asia, the overall funding support for implementation of

programme area 5.1 in 2014–2015 depends on voluntary contributions. High reliance on voluntary

contributions may hamper the capacity of both country and regional offices to fund its HR work plan in

the Programme budget for 2016–2017, which eventually impairs the capacity to implement the

planned activities under this programme area.


In the Regional Office for the Western Pacific, the Programme budget allocation for 2014–2015 was

US$ 15.1 million and was financed at a level of 83%. While funding support from Australia, the

European Union and USAID ended, continued funding from the Asia-Europe Foundation, Canada, CDC,

Japan and the Republic of Korea was obtained. Fund implementation against allocated and available

funds was 83% and 99% respectively.

In headquarters, the approved Programme budget for 2014–2015 was US$ 49.7 million. As of 31

December 2015, the programme area was funded for US$ 40 million (81% of Programme budget). The

expenditure was US$ 37 million, i.e. 74% of Programme budget and 92% of funds available. During

2014–2015, staff resources contributed to support of Ebola outbreak-related activities. In late 2014, a

separate work plan activity budget was set up to deal with Ebola-related activities, with dedicated

financial and staff resources. From mid -2015, the GCR Budget Centre contributed towards

implementation of the IHR Review Committee work plans (US$ 2 million) and the “beyond Ebola” work

plan (US$ 2 million).

The above-mentioned financial issues jeopardized the planning and due implementation of activities, both from the point of view of human resource issues and direct implementation, thus:

Countries could not fully conduct their IHR core capacity assessments and the development of

implementation plans.

There was inadequate sharing of information on the status of IHR implementation.

The mechanism for media monitoring and the early warning system did not function effectively.

Mapping information on epidemic-prone zones at regional level was incomplete.

Public health information was not shared by countries with sufficient frequency, resulting in delayed

responses.

WHO country offices had insufficient capacity to regularly update PHEs through EMS.

There was a limited number of trained and functional rapid response teams at all levels of the health

system, and the rapid response team at the regional level was frequently overwhelmed by the

numbers of major public health events requiring a response.

Some regional activities had to be postponed to the next biennium.

The financial uncertainty meant that work had to be undertaken mainly on an ad hoc basis, preventing

a more long-term, strategic and systematic way of working.

Efficiency measures have been implemented as follows:

In order to conduct IHR core capacity assessments, six countries were financially supported for IHR

assessment and development of national plans.

A network of public health laboratories was established.

Public health event information was regularly shared among relevant stakeholders for decision-

making.

Partnerships were enhanced for implementation of the IHR.

Specific plans and initiatives to achieve efficiencies and cost reductions were established at each level

of the Organization, including efficiency measures to bridge gaps and improve delivery, rationalize

staff number and profiles, rationalize travel costs, reduce the number of external meetings, outsource

work and enhance collaboration with partners.

Additional funds were allocated to implement IHR strategic areas of work.


In the Regional Office for Europe, synergies with related programmes have been further explored; for

example, the IHR programme was involved in two subregional polio outbreak simulation exercises,

which were initiated by the inactivated polio vaccine programme. The same applies to activities under

the Pandemic Influenza Preparedness. Framework, which were initiated by the Influenza and Other

Respiratory Pathogens (IRP) programme.

IV. LESSONS LEARNED AND OUTLOOK FOR 2016–2017 Lessons learned in 2014–2015

The programme area will continue to enhance the monitoring of public heath events using the Event

Management System (EMS) and other existing tools and fully utilize the Strategic Health Operations

Centre (SHOC) system for management of information on major epidemic diseases.

Using the lessons learned from the Ebola virus disease outbreak in West Africa, the Regional Office for

Africa in close collaboration with relevant stakeholders will strengthen the capacity of rapid response

teams.

The establishment of the regional emergency operation centre network is crucial for harmonizing the

coordination of responses to major public health events.

The programme area will continue to work with key partners in the harmonization of country support

for the scale up of IDSR and the attainment of IHR core capacities, and the mobilization of the needed

resources to support this.

Regular monitoring of the implementation of the IHR and IDSR by Member States in the Region will be

done using the updated standard tools, taking into account the lessons learned from the Ebola virus

disease outbreak and recommendations from the World Health Assembly and the Regional

Committee.

Significant gaps remain in preparedness and readiness to respond to outbreaks, posing risks not only

to the countries concerned but also to the entire global community.

To facilitate more accurate monitoring and evaluation of IHR (2005) core capacities, a new more

flexible approach is called for, which allows a combination of self-assessment and external

evaluations.

HQ, regional and country offices are currently understaffed, undermining rapid and efficient outbreak

responses when faced with public health events of the magnitude of the Ebola virus disease outbreak

in West Africa.

Human resources and financial resources at the regional and country levels need to be strengthened

to support the implementation of the IHR at national level.

Good collaboration and coordination across the categories, programme areas and units will continue

to contribute to the above-mentioned achievements.

Impediments due to any outbreak and emergency response, including the response to the Ebola crisis In the African Region the major technical areas that were delayed in 2015 due to the response to the Ebola crisis were the support to the countries to implement the roadmap of the “One Health” approach in order to minimize health threats at the human-animal-ecosystem interfaces, and the development of the core capacities under the IHR. EMRO delayed enhancing IHR capacities for the preparedness and response to foodborne diseases, and chemical and radiation events were not addressed in 2015. The capacity at points of entry needs further development, and cross-border collaboration needs to be enhanced. National legislation in most of the countries in the Region needs to be reviewed to facilitate the implementation of the IHR.


Outlook for 2016–2017: planning for the Sustainable Development Goals (SDGs)

The ongoing WHO reform and reorganization process aimed at more effective management of health

emergencies will allow alignment and harmonization of activities to attain the health-related SDGs.

The work undertaken under programme area 5.1 also links to several other SDGs:

o Goal 9: Build resilient infrastructure, promote inclusive and sustainable industrialization and foster innovation.

o Goal 11: Make cities and human settlements inclusive, safe, resilient and sustainable.

o Goal 13: Take urgent action to combat climate change and its impacts.

o Goal 17: Strengthen the means of implementation and revitalize the global partnership for sustainable development.

Resource allocation to highly vulnerable low-capacity countries will allow implementation of priority

IHR core capacities.

More targeted support to address WHO internal capacities at the three levels of the Organization is

needed.

Sustainable and predictable funding to ensure planning and due implementation is required.

Strengthening of monitoring and evaluation and better use of revised performance indicators are

needed.

A multisectoral approach is needed in planning and implementation of activities going forward. Public

health events need to be addressed at the human-animal-ecosystem interface in line with the “One

Health” approach.

The full implementation of the IHR core capacities will promote the all-hazards approach.

Collaboration with other clusters will ensure a multidisciplinary approach to surveillance and response

to epidemic-prone diseases.

programme budget 2014 2015 performance assessment...

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